EFFECT OF A COVID-19-RELATED LOCKDOWN ON MIDDLE-AGED AND OLDER FAMILY CAREGIVERS IN SINGAPORE

Abstract Lockdowns, while limiting COVID-19 transmission, can affect care provision by family caregivers and their caregiving experience. We assessed, among 1094 family caregivers aged 50-79 years in Singapore, the (1) perceived effect of nationwide lockdown on their care provision, (2) correlates of different perceptions, and (3) association of the perceptions with negative and positive caregiving experiences. Caregivers reported whether their care provision became harder, easier, or remained the same during versus before the lockdown. Multinomial logistic regression assessed the association of caregiver, care-recipient, and caregiving-context characteristics with their perceptions. Linear regression models examined the association of their perceptions with subsequent negative and positive caregiving experiences. Care provision became harder for 36%, easier for 18% and remained the same for 46% caregivers. Care provision becoming harder (versus same) was more likely for caregivers who were male, Chinese, in worse health, caring for care-recipients with functional limitations, without caregiving support from cohabiting family before the lockdown, and with caregiving support from non-cohabiting family before the lockdown. Care provision becoming easier (versus same) was less likely among caregivers who were of higher age, unemployed, socially isolated and whose care-recipients had functional limitations. Caregivers for whom care provision became harder were worse off in negative caregiving experiences. A nationwide lockdown did not make care provision harder for all caregivers. However, those for whom it did had greater negative caregiving experiences. Heterogeneity of the effect of lockdowns and offering flexibility to non-cohabiting family who support caregiving should be considerations when implementing such disruptions.

compare within-person variability to that observed across persons.Using multilevel factor analysis we examined the factor structure of activity participation within-persons (i.e., across days) and between participants.Using tabletbased assessments, 81 adults aged 41 to 94 years (M=61.26,SD=12.12) reported the activities they completed in the past 3-4 hours 5 times per day (4 at semi-randomly scheduled intervals and 1 at bedtime) for 14 days.Multilevel factor analysis simultaneously computed both intra-individual factors (within-person structure of activity in daily life) and inter-individual factors (between-person structure of activity engagement).A solution of 4 within-person and 4 between-person factors provided the best model fit, with three common factors across levels: 1) cognitive (e.g., read, write, computer tasks); 2) social (e.g., events, mentoring, providing care); and 3) passive (e.g., TV, games) factors.There were notable differences in the fourth factor however.Although there are similarities, the factor structure of activity participation between individuals is different than factors describing activity participation within persons from day to day.Researchers should be aware that common between-person activity factors will not unilaterally fit EMA within-person data and should conduct additional preparatory factor analyses.While an increasing number of Americans are providing unpaid care to an adult family member, the majority are balancing family care needs with employment responsibilities.Role conflict theory suggests the experience of combining family caregiving and paid work can detrimentally impact mental health, while role enhancement theory suggests that occupying both social roles can alleviate the burden of caregiving.Prior work finds support for both theories, however, there is currently a lack of causal evidence examining how mental health is affected by combining caregiving and employment roles.Additionally, while gendered differences and differences across racial identities in the family caregiving experience are well-documented, even fewer studies have taken an intersectional approach in understanding shifts in mental health when caregiving while employed.The current study uses a causal methodology to examine how the mental health of working adults is impacted when they transition into a family caregiving role and how these impacts vary at the intersections of racial and gender identity.Data are from the Health and Retirement Study (2004Study ( -2018)), a nationally representative survey of U.S. adults aged 50+.Results from fixed effects models support role conflict theory, suggesting when working adults begin family caregiving they experience an increase in depressive symptoms.Additional analysis using an intersectional lens finds this result applied only to White working women who transitioned into a parental caregiving role.Combining care with paid work did not appear to impact depressive symptoms for employed Black women, Black men, and White men when they began caregiving.Emerging evidence suggests that caregivers may experience high rates of suicidal ideation.However, relatively little is known about daily contextual factors, including day-to-day depression and anxiety-related symptoms, that increase the severity of suicidal ideation over time.The purpose of this study was to apply time-varying effect modeling (TVEM) to examine daily depression and anxiety symptoms leading up to an individual's highest suicidal ideation score within a span of 14 days in a sample of community-dwelling ADRD caregivers.The intercept-only model revealed an increase in the mean scores of daily suicidal ideation four days leading up to an individual's highest score.Additionally, there was a significant decrease four days after the highest suicidal ideation point.The relationship between depression and daily suicidal ideation was significant 1-day leading up to the highest suicidal ideation score.Similar relationships were observed with daily anxiety as a time-varying predictor in a separate model.The results from this study suggest that suicidal ideation can vary between days, with depression and anxiety influencing the intensity of the slope leading to and following an individual's highest suicidal ideation score.Examining suicidal ideation trajectories over time and factors associated with varying severity can help inform targeted interventions to support dementia caregivers and mitigate the risk of severe psychological distress associated with dementia caregiving.

THE MENTAL HEALTH TAX OF FAMILY CAREGIVING
Abstract citation ID: igad104.2218

EFFECT OF A COVID-19-RELATED LOCKDOWN ON MIDDLE-AGED AND OLDER FAMILY CAREGIVERS IN SINGAPORE
Rahul Malhotra 1 , Vicky Qin 2 , and Abhijit Visaria 1 , 1. Duke-NUS Medical School, Singapore, Singapore, 2. Nanyang Technological University, Singapore, Singapore Lockdowns, while limiting COVID-19 transmission, can affect care provision by family caregivers and their caregiving experience.We assessed, among 1094 family caregivers aged 50-79 years in Singapore, the (1) perceived effect of nationwide lockdown on their care provision, (2) correlates of different perceptions, and (3) association of the perceptions with negative and positive caregiving experiences.Caregivers reported whether their care provision became harder, easier, or remained the same during versus before the lockdown.Multinomial logistic regression assessed the association of caregiver, care-recipient, and caregiving-context characteristics with their perceptions.
Linear regression models examined the association of their perceptions with subsequent negative and positive caregiving experiences.Care provision became harder for 36%, easier for 18% and remained the same for 46% caregivers.Care provision becoming harder (versus same) was more likely for caregivers who were male, Chinese, in worse health, caring for care-recipients with functional limitations, without caregiving support from cohabiting family before the lockdown, and with caregiving support from non-cohabiting family before the lockdown.Care provision becoming easier (versus same) was less likely among caregivers who were of higher age, unemployed, socially isolated and whose care-recipients had functional limitations.Caregivers for whom care provision became harder were worse off in negative caregiving experiences.A nationwide lockdown did not make care provision harder for all caregivers.However, those for whom it did had greater negative caregiving experiences.Heterogeneity of the effect of lockdowns and offering flexibility to non-cohabiting family who support caregiving should be considerations when implementing such disruptions.

EFFECT OF SELF-GUIDED INTERVENTIONS ON MENTAL HEALTH OF INFORMAL CAREGIVERS: A SYSTEMATIC REVIEW
Eunjung Ko, Thanchanok Wongvibul, Karen Rose, and Jin Jun, The Ohio State University, Columbus, Ohio, United States Informal caregivers of people living with dementia often experience emotional and mental distress due to the demands of caregiving.Self-guided interventions aimed at improving the mental health of these caregivers have emerged, but their effectiveness remains understudied.We systematically examined the effects of self-guided interventions on stress, burden, and mental health of informal caregivers of people living with dementia.PubMed, CINAHL, PsycINFO, Scopus, and Embase databases were searched using relevant search terms for the study aims.Included articles focused on informal caregivers of people living with dementia and self-guided interventions to improve psychological or mental health.Sixteen articles and 1,182 samples were included in this review.Self-guided interventions covered topics on caregiving skills, emotional self-care, and/or information on social or financial resources related to caregiving.Outcomes of each study included stress, burden, depressive symptoms, anxiety, distress, quality of life, self-efficacy, positive aspects of caregiving, and loneliness.Depressive symptoms and burden were the most frequently measured outcomes.Stress was generally reduced after the interventions, whereas the results of burden and mental health from each intervention were inconsistent.Interventions lasting shorter than three months were more likely to be effective compared to longer interventions.Self-guided interventions may be useful for improving mental health of informal caregivers of people living with dementia due to its low time burden, ease-to-access, and affordability.Future research is needed to determine the optimal length and components of self-guided interventions and to collaborate with clinicians for wider distribution to informal caregivers of people living with dementia.The COVID-19 pandemic greatly burdened family caregivers in the United States and across the globe as they and their family members often suffered from the COVID-19 virus and its societal implications, like social isolation and a shift to remote healthcare.This study examines the impact of the COVID-19 pandemic on financial difficulty, health behavior, and mental health outcomes among family caregivers for older adults across the intersectionality of gender and race.Using the 2020 National Health and Aging Trends Study (NHATS) COVID-19 supplement for Family Members and Friends, our sample included adult family or friend caregivers of Medicare beneficiaries aged 65 or older in the US (N = 2,062).We modeled the interrelationships between financial difficulty, health behaviors, and mental health outcomes using a structural equation model.The results indicate that within the intersectionality framework, during the pandemic, female caregivers reported less vigorous activity, more changes in walking and sleeping patterns, and more eating and watching TV than before the pandemic compared to male counterparts.Compared to white caregivers, during the pandemic, non-white caregivers showed less vigorous activity and more changes in walking, sleeping, I eating, and TV watching patterns than before the pandemic.Financial difficulty was significantly and positively associated with negative mental health.Active behavior was significantly and negatively associated with negative mental health.Health professionals should consider the interrelationships between sociodemographic factors, physical activity levels, and financial difficulties that have come to light during the pandemic when designing future programs and policies to improve family caregiver health.Substantial research has been conducted on the high prevalence of anxiety and depression among dementia family caregivers.Stressors, such as financial hardships related to costs of care and feelings of role captivity, can exacerbate adverse mental health outcomes.However, there is limited literature focused specifically on gender differences in the caregiving stress process.Using data from a mixed-methods study of 46 dementia family caregivers between the ages of 23-96, the purpose of this study was to examine gender differences in self-reported caregiving stressors (e.g., cost of care, care intensity) and psychosocial outcomes including depression and anxiety.Results showed that compared to females, male caregivers reported greater costs of care, greater feelings of role captivity, higher frequency of assistance with

HEALTH BEHAVIORS, AND MENTAL HEALTH OF FAMILY CAREGIVERS DURING THE COVID-19 PANDEMIC Yujun
Liu 1 , M. Courtney Hughes 1 , and Heng Wang 2 , 1. Northern Illinois University, DeKalb, Illinois, United States, 2. Rush University Medical Center, Chicago, Illinois, United States

GENDER DIFFERENCES IN PSYCHOLOGICAL OUTCOMES OF DEMENTIA CAREGIVERS Elena
Roden 1 , and Francesca Falzarano 2 , 1. Fordham University, New York City, New York, United States, 2. Weill Cornell Medicine, New York City, New York, United States